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it is impossible for patients to come for skilled mas-
sage and electrotherapeutics, daily treatments of a
certain kind can be instituted by simple instruction
to the parents regarding .giving massage and elec-
tricity, and a brace may also be fitted. Where spe-
cialists are to be employed it is now generally con-
ceded by all that these patients do better with the
orthop.iedic surgeon than with the neurologist.
Just a few words about the operative treatment
and then I am through. No case should be con-
sidered as a surgical proposition until at least eight-
een months have elapsed, and better yet is it to wait
two years. No case should have any surgical inter-
ference no matter how long after the original at-
tack while any spontaneous megatouch funky monkey game online recovery is .going on.
The surgical procedures are three, namely, tendon
I'OI'E: SYPHILIS.
transplantation and fixation, arthrodesis, and nerve
grafting. The last named is the least desirable, as
so far the results obtained in most cases leave
much to be desired. However, it is worthy of trial
if everything else has failed, or if the other two sur-
gical procedures are found impracticable. Arthrod-
esis is preferred by many as better even than megatouch funky monkey online ten-
don manipulation. This view I do not share,
preferring the latter download games online ru funky monkey slots where there is a chance of suc-
cess. The operation of arthrodesis consists simply
of removing the cartilaginous surfaces of articulat-
ing bones and holding them in the position desired
by plaster of Paris bandages until firm ankylosis i>
secured. This operation, like any other surgical
procedure, must be done under the strictest aseptic
precautions. Arthrodesis is sometimes combined
with tendon transplantation. The technique of ten-
don transplantation is too involved to go into a gen-
eral paper as this is. A few pointers however about
this procedure are these : It should be done under an
Esmarch bandage when possible. It should only be
done after all deformities and contractures have
been corrected. Too much should not be attempted
at once. .Small normal muscles should not be ex-
pected to take up the work of larger paralyzed ones
besides their own. .\fter the operation, when the
plaster of Paris bandage has been removed from
the limb which, following the play funky monkey barrel game online free operation had been
put up in an overcorrected position, a light brace
should be worn for a while and massage and elec-
tricity continued for a variable while. Muscle edu-
cation must also be commenced again.
i6o West Oxf. Hcxdred .vnd Sixth Street.
AX INSTRUCTIVE C.\SE OF SYPHILIS. FOL-
LOWED BY P.^RESIS.
By Curr.^x Pope, M. D.,
Louisvilh, Ky.,
Former Professor of Nervous and Mental Diseases, Louisville Medi-
cal (^ollc^c: funky monkey game online barrels .Medical Supcrinlcnuem. The Pope Sanntoriuni.
In the long retrospect of the practice of two dec-
ades, when one looks backward through the vista
of experiences, certain cases are apt to stand out
with startling clearness, to be impressed upon the
memory indelibly. Doubtless every physician has
to suffer, to suffer intensely for those real errors.
for the sad mistakes he makes, to wish profoundly
that things might have been otherwise, that his
view might have been clearer, and his prophecy
more prophetic. These mistakes are indeed the
■"slings and arrows of outrageous fortune" that
gall and irritate, that serve to teach yet greater
care, nvire thought fulness, and deeper study, but
to suffer for what we reasonably know to 1)C
the truth, to know that we are maligned for our
truthfulness, cursed for our knowledge, makes us
realize of what strength must have been the cour-
age, moral anrj physical, that uplifted the martyrs
during the hours of their trial play funky monkey online free and tribulation. One
would indeed lie untruthful were he not to confess
"to a feeling of pride, a pleasant glow of satisfaction
upon finding that he is correct after the lapse of
many years, to see the fulfillment of his diagnosis,
to kfww that he was correct. This would play funky monkey barrel game online indeed
transcend the justified feelings of professional satis-
faction were it not for the sad terminations that
marked the outcome of the diagnosis, to funky monkey slots free feel that
after all a human being suft'ers, when things might
( ?) have been so different. One's recollection of
his own indignation and what he underwent, tem-
pers his feelings to the "shorn lamb's." But let us
put aside our retrospective musings and come to
the more interesting details of the case in hand.
.\bout a decade ago, I was asked to see a case by
a brother practitioner. It was, alas, one of those
instances where the family forced the consultation
and selected the consultant ; so much the worse for
me. Totally unaware of the hidden and smoldering
fires beneath the volcanic crust upon which I so
cheerfully walked, I promptly complied. I was not
enlightened by the medical advisor or family, with
which explanation I record the case. The anamne-
sis ran as follows :
' Case. A man of business, aged fifty-two years, had
been complaining for a number of months of anomalous
symptoms largely pointing toward the nervous system, es-
pecially the brain. He was married, his wife was living,
and of the union five children had been born, one prema-
turely ; one lived a few weeks, and the other three aged
respectively eighteen, sixteen, and eleven years were living.
The oldest, a girl, was nervous and had had "minor" hys-
terical attacks ; the boy, aged si.xteen, was strong, well
i)uilt, intelligent, and healthy : funky monkey slot the boy, aged eleven years
had had acute articular rheumalism and an attack of chorea
from both of which he had seemingly recovered, although
his growth was hardly up to my idea of a boy of that age.
The patient was about five feet, eight inches in height,
weighed usually 150 pounds, but at present weighed 14S
pounds, gross (unstripped). He was dark skinned, mark-
edly so of face, the skin play funky monkey online being rather dry and leathery
looking. He had badly shaped ears, irregular eycbrou.s.
widely set eyes, and a more active innervation of one side
of his face, that gave him a peculiar expression A\hcn his
face became mobile. He was able to give a very clear ac-
count of his life. He came of funky monkey slot game fairly gRod stock, though
two maternal aunts had had tuberculosis. The pulmonary
form was fatal to one, but the other made .i complete re-
covery from the bone tuberculosis, which attacked the tibia ; funky monkey game free online
curetment and subsequent treatment proving efficient. On
the paternal side one individual had died insane but he
could not give details as the relative Ii\ ed in funky monkey game play online a distant
State. His father and motlicr had liecn both healthy ; the
mother having free online funky monkey barrel game died of pneumonia, the father beiiig yet
alive, active, and in possession of all his faculties at the
age of seventy-nine years. The patient himself was healthy
as an infant, was funky monkey online game breast fed and grew rapidly. He lived
on the farm until his twelfth year when his parents re-
moved to the city, where he had resided ever since. He
had had little education : country school and a few years
in the primary branches of the city school svstem. Had
been ambitious and read a great deal so as to "educate him-
self, taking especial pride in "keeping up with events."
He had been rarely sick, measles, mumps, and cliickenpox.
he remembered. He started as a clerk when about sixteen
or seventeen years funky monkey online free games of age. Was always industrious and
sober, in fact drank practically nothing until ten or twelve
years ago, when fortune smiled on him. He then began to
.seek more "relaxation," which included free indulgence at
table, and gradually increasing consumption of alcohol in
all its forms. Had always used tobacco excessively, both
chewing and smoking Denied any genitourinary infections,
any specific disease or any opportunity for the contraction
of same, claiming he came to the marital bed in a state ot
virginity, and had never lapsed subsequently. Had al-
ways gotten along well in his family. During his early
married life there were no children, assigning "financial
reasons" as the cause, although both he and his Wife really
wanted children "to bless the union." He had always been
of a rather quiet religious type and fairly regular church
attendant. About two years ago he began to lose his
health, funky monkey slots review first noticing some "indigestion" with an accom-
panying insomnia, the "result of the stomach trouble."